Long-Term Outcomes of Sacral Neuromodulation Explantation: A 12-Year Experience at a High-Volume Tertiary Center.

INTRODUCTION

Sacral neuromodulation (SNM) is a therapeutic option offered to patients with idiopathic overactive bladder (OAB) or non-obstructive urinary retention, as an alternative treatment for refractory medical management. It allows for electrical stimulation of inhibitory circuits that modulate the micturition reflex and improve lower urinary tract symptoms. Despite high efficacy and safety, explantation remains a challenge clinically as it is unknown which factors predict explantation. Herein, we sought to understand the factors influencing SNM explantation.

METHODS

We conducted a long-term retrospective cohort study of 587 patients receiving SNM at one academic tertiary care center in Toronto, Ontario, performed by one surgeon.

RESULTS

The Kaplan-Meier analysis demonstrated explantation-free survival probabilities of 97% (95% CI 96%-99%) at 1 year, 92% (90%-95%) at 3 years, and 81% (77%-86%) at 5 years. We did not determine any variables independently associated with time nor risk of explantation. The most common indication for explantation was loss of efficacy (57.7%), followed by patient preference (16.7%) and pain (16.7%).

CONCLUSION

Explantation after SNM occurs in a minority of patients, and is largely attributable to a loss of sustained therapeutic efficacy over time.